Surgical clamp and clamp jaw

ABSTRACT

A surgical clamp jaw is disclosed, having an inner profile and a deflection control profile opposite the inner profile. In one embodiment, the inner profile has a first substantially concave profile in an unclamped position and a second substantially flat profile in a clamped position. In one embodiment, the deflection control profile has one or more sets of corresponding abutment surfaces, at least one set of which is not contacting each other when the inner profile is in the unclamped position and which is contacting each other when the inner profile is in the clamped position. In one embodiment, the surgical clamp jaw defines one or more flexion assistance voids, wherein at least one of the one or more flexion assistance voids is in contact with a gap between one of the one or more sets of corresponding abutment surfaces.

FIELD

The claimed invention relates to clamping devices, and more specificallyto a surgical clamp and clamp jaw.

BACKGROUND

During certain surgical procedures, it may be necessary to securelyclamp and/or occlude body conduits (for example, blood vessels) ofvarious sizes and thicknesses. Gripping or clamping instruments areoften used in many types of medical procedures such as heart, lung,bariatric, and vascular surgeries. Existing clamps provide littlefeedback regarding how tightly the clamp is attached to a particulartissue. This can result in clamps which are holding tissue too tightlyor too loosely. In the case where tissue, such as a blood vessel, isheld too loosely, unexpected blood flow or blood loss may complicate asurgery, especially if the loose clamp falls off In the case wheretissue is held too tightly, the tissue may be physically damaged from anexcessive clamping force and/or biologically damaged due to excessivelyreduced blood flow to the tissue in the region where the clamp isapplied. Furthermore, depending on the design, if a surgical clamp isattached too tightly, it may have a tendency to be forced off theclamped tissue if the tissue is slippery.

In addition to clamping considerations to ensure surgical clamps areable to properly occlude body conduits, the prior art often overlooksconcerns for how such clamps release. As one example, surgeonsfrequently use aortic cross clamps to occlude blood flow from the heartthrough the aorta as part of many heart surgeries, such as coronaryartery bypass or aortic valve replacement surgeries. When such surgeriesare near completion, and the surgeon is ready to unclamp the aorta, itmay be desirable to remove the cross clamp slowly in order to avoidprofound hypertension which may result from rapid reperfusion. This slowrelease can be difficult with some clamps as their jaws tend to create aV-shape as they are opened, thereby increasing the likelihood that thepreviously clamped vessel will suddenly push itself out of the clamptowards the open end of the “V”, regardless of how carefully or slowlythe surgeon is trying to open the clamp.

Therefore, there is a need for a surgical clamp and clamp jaw which hasa reliable indication of when it is properly clamped in order toincrease holding strength while reducing potential tissue damage due toexcessive clamping force. Furthermore, there is also a need for asurgical clamp and clamp jaw which enables a more controlled clamprelease process in order to reduce the risk of tissue damage due topressure spikes from reestablished blood flow when clamps are removed.

SUMMARY

A surgical clamp jaw is disclosed, having an inner profile and adeflection control profile opposite the inner profile.

Another surgical clamp jaw is disclosed, having an inner profile. Theinner profile has a first substantially concave profile in an unclampedposition and a second substantially flat profile in a clamped position.The surgical clamp jaw also has a deflection control profile oppositethe inner profile, the deflection control profile comprising one or moresets of corresponding abutment surfaces. The abutment surfaces in atleast one of the one or more sets of corresponding abutment surfaces arenot contacting each other when the inner profile is in the unclampedposition. The abutment surfaces in at least one of the one or more setsof corresponding abutment surfaces are in contact with each other whenthe inner profile is in the clamped position. The surgical clamp jawdefines one or more flexion assistance voids, wherein at least one ofthe one or more flexion assistance voids is in contact with a gapbetween one of the one or more sets of corresponding abutment surfaces.

A surgical clamp is also disclosed, having a first surgical clamp jawand a second surgical clamp jaw. The first surgical clamp jaw has afirst inner profile and a first deflection control profile opposite thefirst inner profile. The second surgical clamp jaw has a second innerprofile and a second deflection control profile opposite the secondinner profile. The surgical clamp also has one or more actuatorsconfigured to create relative movement between the first inner profileof the first surgical clamp jaw and the second inner profile of thesecond surgical clamp jaw between an unclamped position and a clampedposition.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a top view of one embodiment of surgical clamp jaws pivotablyheld by a housing.

FIG. 1B is a side view of the embodied surgical clamp jaws of FIG. 1.

FIG. 1C is an exploded perspective view of the embodied surgical clampjaws of FIG. 1.

FIG. 2A illustrates one embodiment of a surgical clamp having anembodiment of the clamp jaws of FIG. 1 in an unclamped position.

FIG. 2B illustrates the embodied surgical clamp of FIG. 2A in a clampedposition.

FIG. 3 illustrates another embodiment of a surgical clamp having anembodiment of the clamp jaws of FIG. 1.

FIG. 4A illustrates another embodiment of a surgical clamp having anembodiment of the clamp jaws of FIG. 1.

FIG. 4B illustrates an embodiment of the surgical clamp of FIG. 4A witha spring biasing element.

FIG. 4C illustrates another embodiment of a surgical clamp having anembodiment of the clamp jaws of FIG. 1, but with a single pivot axis.

FIG. 4D illustrates a further embodiment of a surgical clamp having anembodiment of a single clamp jaw from FIG. 1.

FIG. 5A illustrates one embodiment of a surgical clamp jaw in anunclamped position.

FIG. 5B is an enlarged view of a portion of the surgical clamp jaw ofFIG. 5A, featuring one embodiment of corresponding abutment surfaces andone embodiment of flexion assistance voids.

FIG. 5C illustrates the embodied surgical clamp jaw of FIG. 5A in aclamped position featuring a substantially flat inner profile.

FIG. 6A illustrates another embodiment of a surgical clamp jaw in anunclamped position.

FIG. 6B is an enlarged view of a portion of the surgical clamp jaw ofFIG. 6A, featuring another embodiment of corresponding abutment surfacesand one embodiment of flexion assistance voids.

FIG. 6C illustrates the embodied surgical clamp jaw of FIG. 6A in aclamped position featuring a substantially concave inner profile.

FIG. 7A illustrates a further embodiment of a surgical clamp jaw in anunclamped position.

FIG. 7B illustrates the embodied surgical clamp jaw of FIG. 7A in aclamped position featuring a substantially convex inner profile.

FIGS. 8 and 9 illustrate other embodiments of surgical clamp jaws havingexamples of different flexion assistance void distribution.

FIGS. 10-12 illustrate further embodiments of surgical clamp jawsfeaturing examples of different flexion assistance void shapes.

FIG. 13A illustrates another embodiment of a surgical clamp jaw wherethe sets of corresponding abutment surfaces are not contiguous with theflexion assistance voids.

FIG. 13B is an enlarged view of a portion of the surgical clamp jaw ofFIG. 13A.

FIG. 14A illustrates an embodiment of the surgical clamp jaw of FIG. 5Aalso having an example of an integral gripping surface on the innerprofile.

FIG. 14B is an enlarged view of a portion of the surgical clamp jaw ofFIG. 14A.

FIG. 15A illustrates another embodiment of a surgical clamp jaw havinginterlocking features on corresponding abutment surfaces.

FIGS. 15B-1 and 15B-2 are enlargements of alternate embodiments of theinterlocking features for a surgical clamp jaw based on the embodimentof FIG. 15A.

FIG. 16A illustrates a further embodiment of a surgical clamp jaw havinginterlocking features on corresponding abutment surfaces.

FIG. 16B is an enlarged view of a portion of the surgical clamp jaw ofFIG. 16A.

FIG. 17A illustrates the embodied surgical clamp jaw of FIG. 5A, in anunclamped position, with one embodiment of a shod.

FIG. 17B illustrates the embodied surgical clamp jaw of FIG. 17A in aclamped position.

FIG. 18A illustrates the embodied surgical clamp jaw of FIG. 5A, in anunclamped position, with another embodiment of a shod.

FIG. 18B illustrates the embodied surgical clamp jaw of FIG. 18A in aclamped position.

FIG. 19 illustrates an embodiment of a shod for a pair of surgical clampjaws.

FIG. 20 illustrates the embodied surgical clamp of FIG. 2A with theembodied shod of FIG. 19.

FIGS. 21 and 22 illustrate cross-sectional views of embodiments of asurgical clamp jaw having a shod, wherein the surgical clamp jaw has adeflection control profile defining gaps which are separated by portionsof the shod.

It will be appreciated that for purposes of clarity and where deemedappropriate, reference numerals have been repeated in the figures toindicate corresponding features, and that the various elements in thedrawings have not necessarily been drawn to scale in order to bettershow the features.

DETAILED DESCRIPTION

FIG. 1A is a top view of one embodiment of surgical clamp jaws 30, 32pivotably held by a housing 34. The clamp jaw 30 pivots around pivotpoint 36, while clamp jaw 32 pivots around pivot point 38. FIGS. 1B and1C show the assembly of FIG. 1A in side and exploded views,respectively, in order to better illustrate the embodiment. The housing34 in this embodiment has a top plate 40 and a bottom plate 42. Inaddition to locating the pivot points 36 and 38, the housing plates 40,42 may also be coupled by one or more supports 44.

Each surgical clamp jaw 30, 32 has an inner profile 46 and a deflectioncontrol profile 48 opposite the inner profile 46. The deflection controlprofile 48 may be configured to allow the inner profile 46 to have oneshape when the clamp jaws 30, 32 are in an unclamped position andanother shape when the clamp jaws 30, 32 are in a clamped position.Various embodiments of the inner profile 46 and the deflection controlprofile 48 will be discussed later in this specification.

Since the surgical clamp jaws 30, 32 each are pivotable around theirrespective pivot points 36, 38, each jaw 30, 32 may be coupled to anactuator 50, 52 configured to rotate the respective inner profile 46 ofeach surgical clamp jaw 30, 32 around its respective pivot point 36, 38.Some examples of actuators 50, 52 may include, but are not limited tolevers, arms, gears, pulleys, motors, or any combination or pluralitythereof. Such actuators are well known to those skilled in the art andtherefore, the actuators illustrated and discussed herein are oftenshown as simple arms, such as arms 50, 52, or the like, for simplicity.It should be understood, however, that a wide variety of actuators andtheir equivalents are intended to be covered herein.

In the orientation of FIG. 1A, the actuator 50 can be rotated in aclockwise arc around pivot point 36 to move surgical clamp jaw 30 in asimilar direction towards surgical clamp jaw 32. Likewise, the actuator52 can be rotated in a counterclockwise arc around pivot point 38 tomove surgical clamp jaw 32 in a similar direction towards surgical clampjaw 30. The clamp jaws 30, 32 can also be moved apart from each other byreversing the direction of the actuators.

FIG. 2A illustrates one embodiment of a surgical clamp 54 having anembodiment of the clamp jaws 30, 32 of FIG. 1 in an unclamped position.In this embodiment, the actuators include clamp arms 56, 58 with fingerholes 60, 62. The clamp jaws 30, 32 are illustrated as positioned arounda conduit 64, shown in cross-section. Some non-limiting examples ofconduits may include arteries, veins, other biological vessels, or evenmedical tubing.

When the clamp actuator arms 56, 58 are brought together, the conduit 64receives a first clamping force nearer to the open end 66 of the clamp54 and directed inwards because the inner profile 46 of the clamp jaws30, 32 is substantially concave in the unclamped position. Without beingtied to one particular theory, unlike conventional surgical clamps, thistends to help prevent the conduit 64 from being pushed out of the clamp54 as the jaws 30, 32 are brought together. On reversing this action, inthe process of unclamping, the concave inner profile 46 can also tend tohelp keep the conduit 64 from being pushed prematurely out of the clamp54, thereby helping surgeons to have more control over how quickly orslowly the clamp is released. These benefits, enabled by the deflectioncontrol profile 48, may be helpful in allowing surgeons to avoidprofound hypertension which may result from rapid reperfusion by havingmore control over the clamp when used as an aortic cross clamp.

The deflection control profile 48, as will be discussed in more detaillater, allows the inner profile 46 to change shape between the unclampedposition of FIG. 2A and the clamped position shown in FIG. 2B. In thisembodiment, the inner profile 46 is substantially flat in the clampedposition, and cannot be flexed further, thereby helping to indicate whenthe clamp has been properly set and to avoid the need to apply furtherclamping pressure. Some embodiments of the clamp 54 may also haveinterlocking features 68 on the actuators 56, 58 in order to help holdthe clamp 54 in a closed position without the need for someone tomaintain a clamping pressure.

The embodiments of a surgical clamp jaw disclosed herein, and theirequivalents, may be used in a wide variety of surgical clamps and in awide variety of configurations. As illustrated in FIGS. 2A and 2B, thesurgical clamp jaws 30, 32 may be used in a surgical clamp 54 which haslevered arms 56, 58 directly rotating the clamp jaws 30, 32 aroundrespective pivot points 36, 38. FIG. 3 illustrates another embodiment ofa surgical clamp 70 having an embodiment of the clamp jaws 30, 32 whichare actuated around respective pivot points 72, 74 by gears 76, 78. Inthis embodiment, gears 76, 78 are driven, respectively, by gears 80, 82coupled to arms 84, 86. Geared arrangements may be used to provide amore comfortable range of motion for the arms 84, 86 than may beavailable in a direct lever arrangement. As will be familiar to thoseskilled in the art, the gear ratios may also be adjusted to providespecific mechanical advantage for the person operating the clamp 70.

The surgical clamp jaws 30, 32 may also be used in clamp embodimentswhich are more of a clip style clamp (a clamp which does not have fingerholes and which may have shorter actuator arms), as illustrated theembodiments of FIGS. 4A-4D. FIG. 4A illustrates an embodiment of asurgical clamp 88 having an embodiment of the clamp jaws 30, 32 ofFIG. 1. The features of these clamp jaws 30, 32 have been discussedpreviously, but it is worth noting in the embodiment of FIG. 4A that thesurgical clamp jaws 30, 32 are pivotable around respective pivot points36, 38. In this embodiment, these pivot points 36, 38 do not share acommon pivot axis. Instead, the pivot points 36, 38 are separated by apivot separation distance 90. While not necessary in all embodiments,this separation distance 90 can be used to help keep tissue from beingpinched by the jaws 30, 32 as they are closed. The embodiment of FIG. 4Aalso has actuators 92, 94 with ratcheting surfaces 96, 98 for enablingthe clamp 88 to be locked. The ratchet surfaces 96, 98 can also bedeflected apart to release the clamp 88.

FIG. 4B illustrates another embodiment of a surgical clamp 100. Thissurgical clamp 100 is similar to the clamp of FIG. 4A, the features ofwhich have been discussed previously. The clamp 100 of FIG. 4B, however,also includes a spring biasing element 102. Depending on the embodiment,the spring biasing element 102 could be configured to help push theactuator arms 92, 94 apart or pull them together, thereby enabling thejaws 30, 32 of clamp 100 to be biased open or closed. Spring biasingelement 102 is drawn schematically since there are a wide variety ofsprings or spring elements which could be used to for biasing element102. Such spring elements are well known to those skilled in the art.

FIG. 4C illustrates another embodiment of a surgical clamp 104. Thissurgical clamp 104 is similar to the clamp of FIG. 4A, the features ofwhich have been discussed previously. The clamp 104 of FIG. 4C, however,does not have a pivot separation distance. Instead, the surgical clampjaws 30, 32 of clamp 104 have a common pivot axis 106. Depending on theembodiment, a common pivot axis 106 can have the advantage of removingthe need for a housing. In one sense, the axle 108 which provides thecommon pivot axis 106 can serve a similar function to the housing ofprevious embodiments by tying the surgical clamp jaws 30, 32 together sothey can pivot relative to each other.

The embodiment of FIG. 4C also illustrates that the pivot point 106 maybe offset from the inner profile 46 by an offset distance 110 in orderto mitigate any pinching effect which might be caused by having a singlepivot point 106. Such an offset 110 enables approximation of thebenefits of dual pivot points from previous embodiments. Otherembodiments with a single pivot point may not have such an offset 110.

FIG. 4D illustrates a further embodiment of a surgical clamp 112. Thissurgical clamp 112 is similar to the clamp of FIG. 4C in that it has ashared pivot axis 106 and actuators with ratchet surfaces 96, 98. Theembodiment of FIG. 4D differs, however, in that it has one surgicalclamp jaw 30 as discussed previously, while the other clamp jaw 114 hasa fixed profile. In this example, the fixed profile clamp jaw 114 has aflat profile, but in other embodiments, the profile for the fixedprofile clamp jaw 114 could have other shapes. In embodiments with asingle surgical clamp jaw 30 which has an inner profile 46 and adeflection profile 48 opposite the inner profile 46, the substantiallyconcave shape of the inner profile 46 in the unclamped position canstill work with the fixed profile clamp jaw 114 to help contain aconduit being clamped between the jaws with similar benefits asdescribed previously.

The deflection control profile 48, opposite the inner profile 46, is animportant concept for the embodiments disclosed herein. FIG. 5Aillustrates one embodiment of a surgical clamp jaw 116 in an unclampedposition. The surgical clamp jaw 116 has an inner profile 118 and adeflection control profile 120 opposite the inner profile 118. Althougha portion 122 of the clamp jaw has a straight profile in thisembodiment, when taking into account the totality of the inner profile118, the inner profile 118 still has a substantially concave profile inthe unclamped position. The clamp jaw 116 also has a pivot point 124 andan arm 126 which can be used as an actuator or coupled to anotheractuator.

In this embodiment, the deflection control profile 120 comprises one ormore sets of corresponding abutment surfaces which are best seen in theenlarged view of FIG. 5B. FIG. 5B shows a first set of correspondingabutment surfaces 128A, 128B and a second set of corresponding abutmentsurfaces 130A, 130B. For convenience, only one set of correspondingabutment surfaces 128A, 128B will be discussed, however, it should beunderstood that the other sets of corresponding abutment surfaces willoperate in a similar fashion. In the unclamped position shown in FIG.5B, the set of corresponding abutment surfaces 128A, 128B are notcontacting each other. Instead, they are separated by an abutmentseparation distance 132. Depending on the embodiment, the abutmentseparation distance 132 between each set of corresponding abutmentsurfaces 128A, 128B may be the same or different. As the surgical clampjaw 116 is moved from an unclamped position (shown in FIG. 5A) to aclamped position (shown in FIG. 5C), the inner profile 118 will be ableto deflect back towards the deflection control profile 120 until theabutment surfaces 128A, 128B come into contact with each other. Aclamping force 134, from the clamp jaw 116 acting in concert withanother clamp jaw (not shown, but discussed previously), acts on theclamp jaw 116 in order cause the deflection. The abutment separationdistance 132 can be established to control the amount of deflectionpossible for the inner profile 116. Smaller abutment separation 132 willenable less deflection, while larger abutment separation 132 will enablemore deflection. In this embodiment, the inner profile 118 issubstantially flat in the clamped position, as illustrated in FIG. 5C.

In order for the inner profile 118 to be able to deflect until thecorresponding abutment surfaces 128A, 128B contact each other, someembodiments may include one or more flexion assistance voids 136. Theflexion assistance voids 136 reduce the effective thickness 138 of theclamp jaw 116 in certain places behind the inner profile 118, therebymaking the inner profile 118 more flexible. In the embodiment of FIGS.5A-5C, the flexion assistance voids 136 have a substantially triangularshape, although other embodiments may use other shapes. Also, in thisembodiment, each flexion assistance void 136 is in contact with the gap132 between the set of corresponding abutment surfaces 128A, 128B. Thiscontinuity between the gap 132 and the flexion assistance void 136 maybe desirable from a manufacturing point of view, but it is not necessaryin all embodiments.

FIG. 6A illustrates another embodiment of a surgical clamp jaw 140 in anunclamped position. The surgical clamp jaw 140 has an inner profile 142and a deflection control profile 144 opposite the inner profile 142.Although a portion 146 of the clamp jaw 140 has a straight profile, inthis embodiment, when taking into account the totality of the innerprofile 142, the inner profile 142 has a first substantially concaveprofile in the unclamped position. The clamp jaw 140 also has a pivotpoint 148 and an arm 150 which can be used as an actuator or coupled toanother actuator.

As with the previous embodiment, in this embodiment, the deflectioncontrol profile 144 comprises one or more sets of corresponding abutmentsurfaces which are best seen in the enlarged view of FIG. 6B. FIG. 6Bshows a first set of corresponding abutment surfaces 152A, 152B and asecond set of corresponding abutment surfaces 154A, 154B. Forconvenience, only one set of corresponding abutment surfaces 152A, 152Bwill be discussed, however, it should be understood that the other setsof corresponding abutment surfaces will operate in a similar fashion. Inthe unclamped position shown in FIG. 6B, the set of correspondingabutment surfaces 152A, 152B are not contacting each other. Instead,they are separated by an abutment separation distance 156. The abutmentseparation distance 156 in the embodiment of FIGS. 6A-6C is smaller thanthe abutment separation distance 132 from the embodiment of FIGS. 5A-5C.As a result, by comparison, the embodiment illustrated in FIGS. 6A-6C isnot able to deflect as far. Accordingly, as the surgical clamp jaw 140is moved from an unclamped position (shown in FIG. 6A) to a clampedposition (shown in FIG. 6C), the inner profile 142 will be able todeflect back towards the deflection control profile 144 until theabutment surfaces 152A, 152B come into contact with each other,resulting in the inner profile 142 having a second substantially concaveprofile in the clamped position of FIG. 6C. While having a concaveprofile in the clamped position may not be useful for completelyoccluding some conduits, the concave clamped profile may allow a surgeonto partially occlude a conduit. Such a clamp could be used inconjunction with a completely occluding clamp in order to help avoidsudden pressure changes inside the conduit. For example, the conduitcould be partially occluded with one clamp and then completely occludedwith a second clamp, each clamp having differing inner profiles in theclamped position. Near the end of the surgical procedure, the completelyoccluding clamp could be removed first, allowing some fluid to flowthrough the partially occluded clamp. This might allow the surgeon toease the patient's related biological systems into full use as thepartially occluded clamp would later be released.

As with the previous embodiment, a clamping force 158, from the clampjaw 140 acting in concert with another clamp jaw (not shown, butdiscussed previously) acts on the clamp jaw 140 in order cause thedeflection. The clamp jaw 140 in this embodiment also has flexionassistance voids 136, the features of which have been discussedpreviously.

FIG. 7A illustrates another embodiment of a surgical clamp jaw 160 in anunclamped position. The surgical clamp jaw 160 has an inner profile 162and a deflection control profile 164 opposite the inner profile 162.Although a portion 166 of the clamp jaw 140 has a straight profile inthis embodiment, when taking into account the totality of the innerprofile 162, the inner profile 162 has a substantially concave profilein the unclamped position. The clamp jaw 160 also has a pivot point 168and an arm 170 which can be used as an actuator or coupled to anotheractuator.

As with the previous embodiments, in this embodiment, the deflectioncontrol profile 164 comprises one or more sets of corresponding abutmentsurfaces. For convenience, only one set of corresponding abutmentsurfaces 172A, 172B will be discussed, however it should be understoodthat the other sets of corresponding abutment surfaces will operate in asimilar fashion. In the unclamped position shown in FIG. 7A, the set ofcorresponding abutment surfaces 172A, 172B are not contacting eachother. Instead, they are separated by an abutment separation distance174. The abutment separation distance 174 in the embodiment of FIGS.7A-7B is larger than the abutment separation distance 132 from theembodiment of FIGS. 5A-5C. As a result, by comparison, the embodiment ofFIGS. 7A-7B is able to deflect farther. Accordingly, as the surgicalclamp jaw 160 is moved from an unclamped position (shown in FIG. 7A) toa clamped position (shown in FIG. 7B), the inner profile 162 will beable to deflect back towards the deflection control profile 164 untilthe abutment surfaces 172A, 172B come into contact with each other,resulting in the inner profile 162 having a substantially convex profilein the clamped position of FIG. 7B. While having a convex inner profilein the clamped position would not be useful in many situations, such aclamp might be useful where softer gripping forces are needed or wherethe clamp had to be used to hold or steady an unusually shapedstructure. The clamp jaw 160 in this embodiment also has flexionassistance voids 136, the features of which have been discussedpreviously.

In the embodiments discussed up to this point, the flexion assistancevoids 136 have been located in a section of the surgical clamp jawsstarting near the pivot point and ending before a straight section atthe tip of the clamp. Other embodiments may have different distributionsof flexion assistance voids. As just two examples, FIGS. 8 and 9illustrate embodiments of surgical clamp jaws 176 and 178 havingexamples of different flexion assistance void distribution. In FIG. 8,surgical clamp jaw 176 has flexion assistance voids 180 which arelocated near to the tip of the clamp jaw 176, while the clamp jaw 176also has a straight section 182 nearer to the pivot point 184. Even withthe straight section 182, the clamp jaw 176 still has a substantiallyconcave inner profile 186 in the unclamped position illustrated in FIG.8. The clamp jaw 176 also has a deflection control profile 188 oppositethe inner profile 186. The features of deflection control profiles havebeen discussed previously.

In FIG. 9, surgical clamp jaw 178 has flexion assistance voids 190 whichare distributed continuously between the pivot point 191 and the tip ofthe clamp jaw 178. The clamp jaw 178 has a substantially concave innerprofile 192 in the unclamped position illustrated in FIG. 9. The clampjaw 178 also has a deflection control profile 194 opposite the innerprofile 192. The features of deflection control profiles have beendiscussed previously.

FIGS. 10-12 illustrate further embodiments of surgical clamp jawsfeaturing examples of different flexion assistance void shapes. Up tothis point, the flexion assistance voids have been illustrated assubstantially triangular, however, as has been noted above, the flexionassistance voids are not limited to one particular shape. For example,as with the surgical clamp jaw 196 illustrated in FIG. 10, the flexionassistance voids 198 are substantially rectangular. As another example,the surgical clamp jaw 200 illustrated in FIG. 11 has flexion assistancevoids 202 which are substantially circular. Depending on the embodiment,the shapes of flexion assistance voids in a given surgical clamp jaw donot have to be uniform. As just one example, the surgical clamp jaw 204illustrated in FIG. 12 has substantially triangular flexion assistancevoids 206, a substantially circular flexion assistance void 208, anddifferently sized substantially rectangular assistance voids 210, 212.Other flexion assistance void shapes may be used in other embodiments.

In the embodiments of FIGS. 10-12, each flexion assistance void is incontact with a gap 214 between a set of corresponding abutment surfaces.However, depending on the embodiment, a flexion assistance void does notneed to be in contact with a gap between corresponding abutmentsurfaces. For example, FIG. 13A illustrates one embodiment of a surgicalclamp jaw 216 in an unclamped position. The surgical clamp jaw 216 hasan inner profile 218 and a deflection control profile 220 opposite theinner profile 216. Although a portion 222 of the clamp jaw 216 has astraight profile, in this embodiment, when taking into account thetotality of the inner profile 218, the inner profile 218 has asubstantially concave profile in the unclamped position. The clamp jaw216 also has a pivot point 224 and an arm 226 which can be used as anactuator or coupled to another actuator.

In this embodiment, the deflection control profile 220 comprises one ormore sets of corresponding abutment surfaces which are best seen in theenlarged view of FIG. 13B. FIG. 13B shows a set of correspondingabutment surfaces 228A, 228B. For convenience, only one set ofcorresponding abutment surfaces 228A, 228B will be discussed, however itshould be understood that the other sets of corresponding abutmentsurfaces will operate in a similar fashion. In the unclamped positionshown in FIG. 13B, the set of corresponding abutment surfaces 228A, 228Bare not contacting each other. Instead, they are separated by anabutment separation distance 230. Depending on the embodiment, theabutment separation distance 230 between each set of correspondingabutment surfaces 228A, 228B may be the same or different. As thesurgical clamp jaw 216 is moved from an unclamped position (shown inFIG. 13A) to a clamped position (not shown), the inner profile 218 willbe able to deflect back towards the deflection control profile 220 untilthe abutment surfaces 228A, 228B come into contact with each other. Aswith previous embodiments, the abutment separation distance 230 can beestablished to control the amount of deflection possible for the innerprofile 218. In this embodiment, the surgical clamp jaw 216 also hasflexion assistance voids 232 which are not in contact with the gap 230between a set of corresponding abutment surfaces 228A, 228B. The flexionassistance voids 232 will still serve to increase the flexibility of theinner profile 218.

Although the inner profiles of the surgical clamp jaws illustrated tothis point have had a smooth surface, other embodiments may have a roughsurface for the inner profile. For example, FIG. 14A illustrates oneembodiment of a surgical clamp jaw 234 in an unclamped position. Thesurgical clamp jaw 234 has an inner profile 236 and a deflection controlprofile 238 opposite the inner profile 236. In this embodiment, theinner profile 236 is textured. This could be useful, for example, toincrease the grip of the inner profile 236.

Although a portion 240 of the clamp jaw is straight in this embodiment,when taking into account the totality of the inner profile 236, theinner profile 236 still has a substantially concave profile in theunclamped position. FIG. 14B shows an enlarged view of a portion of thesurgical clamp jaw 234 of FIG. 14A. The remainder of the features of thesurgical clamp jaw 234 are similar to the embodiments discussedpreviously and have corresponding element numbers.

The advantages of having a surgical clamp jaw with a concave innerprofile in the unclamped position have been discussed above. Theseadvantages include, but are not limited to, helping to prevent a conduitfrom being pushed out of the clamp as the clamp is tightened into aclamped position and helping to prevent the conduit from popping out ofthe clamp too soon as the clamp is opened (thereby giving surgeons morecontrol over the release of the clamp). For embodiments where the clampjaws need to be held in a clamped position without the need for a personholding the clamp shut, various locking elements can be applied to theclamp jaw actuators to help hold the clamp together. As just someexamples, there are the ratchet features shown on the arms of the clampsin FIGS. 4A-4D, discussed previously. In some embodiments, however, itmay be desirable to replace or supplement the actuator locking featureswith interlocking features located in one or more sets of correspondingabutment surfaces of the deflection control profile. As one example,FIG. 15A illustrates another embodiment of a surgical clamp jaw 242having interlocking features (discussed below) on corresponding abutmentsurfaces. The surgical clamp jaw 242 has an inner profile 244 and adeflection control profile 246 opposite the inner profile 244. The innerprofile 244 has a substantially concave profile in the unclampedposition. The clamp jaw 242 also has a pivot point 248 and an arm 250which can be used as an actuator or coupled to another actuator.

In this embodiment, the deflection control profile 246 comprises one ormore sets of corresponding abutment surfaces which are best seen in thealternate enlarged views of FIGS. 15B-1 and 15B-2. The features ofcorresponding abutment surfaces have been discussed previously.Therefore, for convenience, only one set of corresponding abutmentsurfaces 252A, 252B will be discussed. It should be understood, however,that the other sets of corresponding abutment surfaces will operate in asimilar fashion. In the embodiments illustrated in FIGS. 15B-1 and15B-2, the first abutment surface 252A has a first interlocking feature254A, while the second abutment surface 252B has a second interlockingfeature 254B. In the embodiment of FIG. 15B-1 the first and secondinterlocking features 254A, 254B are not in contact with each other whenthe inner profile 244 is in an unclamped position. In the alternateembodiment of FIG. 15B-2, the first and second interlocking features254A, 254B are contacting each other when the inner profile 244 is in anunclamped position. In either case, in the unclamped position, theabutment surfaces 252A, 252B are still separated and the first andsecond interlocking features are not interlocked.

As the surgical clamp jaw 242 is moved from an unclamped position (shownin FIG. 15A) to a clamped position (not shown), the inner profile 244will be able to deflect back towards the deflection control profile 246until the abutment surfaces 252A, 252B come into contact with eachother. As the corresponding abutment surfaces 252A, 252B come together,the corresponding interlocking features 254A, 254B will also be forcedtogether into an interlocking arrangement. This can help to offset thetendency of the inner profile 244 to want to return to a concaveposition, which may be desirable in some situations.

FIG. 16A illustrates a further embodiment of a surgical clamp jaw 256having a different arrangement of interlocking features 258A, 258B oncorresponding abutment surfaces 260A, 260B. These features are best seenin the enlarged view of FIG. 16B which highlights a portion of thesurgical clamp jaw 256 of FIG. 16A. The interlocking features 258A, 258Bin this embodiment are oriented approximately ninety degrees from theinterlocking features 254A, 254B of the previous embodiment. Afterseeing these examples, those skilled in the art will appreciate thatother types of interlocking features in corresponding abutment surfacesare possible.

Up to this point, the surgical clamp jaw embodiments have been discussedand shown as if the inner profile of the clamp jaw would be in directcontact with any tissue that it is clamping. While such embodiments arevery useful, it may also be advantageous to provide a shod (in this casea covering) for at least a portion of the clamp jaw. As one example,FIG. 17A illustrates the embodied surgical clamp jaw 116 of FIG. 5A(previously discussed), in an unclamped position, with one embodiment ofa shod 262. The shod 262 has an opening 264 on a first end where theclamp jaw 116 may be inserted. In this embodiment, the opposite end 266of the shod 262 is closed. FIG. 17B illustrates the embodied surgicalclamp jaw 116 of FIG. 17A in a clamped position. The shod 262 ispreferably flexible enough to move with the inner profile 118 as itchanges shape moving from the unclamped position to the clampedposition. The shod 262 (and all shod embodiments to be discussed herein)may be made from a wide variety of materials, including, but not limitedto plastics, rubber, silicone, polymers, thermoplastics, resins, fabric,cotton, and fibers.

FIG. 18A illustrates the embodied surgical clamp jaw 116 of FIG. 5A(previously discussed), in an unclamped position, with anotherembodiment of a shod 268. The shod 268 has a first opening 270 on afirst end where the clamp jaw 116 may be inserted. In this embodiment,the shod 268 also has a second opening 272 in a second end. In someembodiments, the second opening 272 may be a by-product of the fact thatthe shod could be manufactured from tubing that is cut to a particularlength. In other embodiments, the second opening 272 may be specificallymolded or formed. The second opening 272 can have the advantage ofmaking the shod 268 easer to put on the surgical clamp jaw 116 since aircannot be caught and/or compressed into a closed end of the shod 268.FIG. 18B illustrates the embodied surgical clamp jaw 116 of FIG. 18A ina clamped position. The shod 268 is preferably flexible enough to movewith the inner profile 118 as it changes shape moving from the unclampedposition to the clamped position.

Although clamp jaw shods have been discussed and shown to this point asbeing configured to fit a single clamp jaw, in other embodiments, a shodcould be formed to cover more than one surgical clamp jaw. For example,FIG. 19 illustrates an embodiment of a shod 274 for a pair of surgicalclamp jaws (not shown in this figure). Shod 274 has a first set ofopenings 276A, 276B (not visible from this angle) on a first end and asecond set of openings 278A, 278B on a second end. FIG. 20 illustratesthe embodied surgical clamp 54 of FIG. 2A with the embodied shod 274 ofFIG. 19, showing that the shod 274 is able to flex with the surgicalclamp jaws. The shod 274 may include a notch 280 which can be pulledover a corresponding feature 282 on the clamp 54 in order to help anchorthe shod 274 in place. The shod 274 may also include a tab 284 to makeit easier to install and remove the notch 280 from the correspondingfeature 282 on the clamp 54.

At the beginning of this specification, one embodiment of a surgicalclamp jaw was described as having an inner profile and a deflectioncontrol profile opposite the inner profile. In the ensuing embodimentsdiscussed up to this point, the deflection control profile included oneor more sets of corresponding abutment surfaces which are not in contactwith each other when the inner profile is in an unclamped position, butare in contact with each other when the inner profile is in a clampedposition. Other embodiments of a deflection control profile arepossible, however. For example, FIG. 21 illustrates a cross-sectionalview of an embodiment of a surgical clamp jaw 286 having a shod 288,wherein the surgical clamp jaw 286 has a deflection control profile 290defining gaps 292 which are separated by portions of the shod 288. Theclamp jaw 286 also has a substantially concave inner profile 294opposite the deflection control profile 290. As the inner profile 294 iscaused to deflect back towards the deflection control profile 290, theshod 288 material in the gaps 292 will be compressed. At some point,depending on the properties of the shod 288 material, the material inthe gaps 292 will not compress further under normal clamping forces, andthe inner profile will have a second profile shape in the clampedposition. In this case, a shod 288 material may be chosen to compress insuch a way that this second profile shape (not shown here) issubstantially concave, substantially flat, or substantially convex.

In some embodiments, the properties which might make for a good shodmaterial (in terms of gripping ability, for example) might not make fora desired compression property in the gaps defined by the deflectioncontrol profile. In such a situation, the shod could include more thanone material. For example, FIG. 22 illustrates a cross-sectional view ofan embodiment of a surgical clamp jaw 296 having a shod 298 with a firstmaterial 300 at least over a portion of the inner profile 302. The shod298 also has a second material 304 separating the gaps defined by thedeformation control profile 306. Alternatively, this second material 304could be separate from the first material 300 and therefore not part ofthe shod 298. The second material 304 may be selected for itscompression properties independently of the properties of the firstmaterial 300. The inner profile 302 is substantially concave in theunclamped position illustrated in FIG. 22. As the inner profile 302 iscaused to deflect back towards the deflection control profile 306, thesecond material 304 in the gaps of the deflection control profile 306will be compressed. At some point, depending on the properties of thesecond material 304, the second material 304 will not compress furtherunder normal clamping forces, and the inner profile 302 will have asecond profile shape in the clamped position. In this case, the secondmaterial 304 may be chosen to compress in such a way that this secondprofile shape (not shown here) is substantially concave, substantiallyflat, or substantially convex.

Various advantages of a surgical clamp and clamp jaw have been discussedabove. Embodiments discussed herein have been described by way ofexample in this specification. It will be apparent to those skilled inthe art that the forgoing detailed disclosure is intended to bepresented by way of example only, and is not limiting. Variousalterations, improvements, and modifications will occur and are intendedto those skilled in the art, though not expressly stated herein. Thesealterations, improvements, and modifications are intended to besuggested hereby, and are within the spirit and the scope of the claimedinvention. Additionally, the recited order of processing elements orsequences, or the use of numbers, letters, or other designationstherefore, is not intended to limit the claims to any order, except asmay be specified in the claims. Accordingly, the invention is limitedonly by the following claims and equivalents thereto.

What is claimed is:
 1. A surgical device, comprising: first and secondclamp jaws, at least one of which is pivotable relative to the other;first and second locking suture guides configured to receive at leastone locking suture for knotting to hold the first and second clamp jawsin a clamped position.
 2. The surgical device of claim 1, wherein: thefirst clamp jaw comprises a first pivot point between a first clampingsurface and the first locking suture guide; and the second clamp jawcomprises a second pivot point between a second clamping surface and thesecond locking suture guide.
 3. The surgical device of claim 1, wherein:the first clamp jaw comprises a first clamping surface between the firstlocking suture guide and a first pivot point; and the second clamp jawcomprises a second clamping surface between the second locking sutureguide and a second pivot point.
 4. The surgical device of claim 1,wherein: the first clamp jaw comprises the first locking suture guidebetween a first clamping surface and a first pivot point; and the secondclamp jaw comprises the second locking suture guide between a secondclamping surface and a second pivot point.
 5. The surgical device ofclaim 1, wherein the first and second clamp jaws have respective pivotpoints which share a common pivot axis.
 6. The surgical device of claim1, wherein the first and second clamp jaws have respective pivot pointswhich do not share a common pivot axis.
 7. The surgical device of claim1, further comprising at least one suture retainer configured to resistseparation of the at least one locking suture from the first or secondclamp jaws.
 8. The surgical device of claim 1, wherein the at least onesuture retainer comprises a tapered channel.
 9. The surgical device ofclaim 1, further comprising: an introducer shaft coupled to at least oneof the first and second clamp jaws.
 10. The surgical device of claim 9,wherein the introducer shaft is pivotably coupled to said at least oneof the first and second clamp jaws.
 11. The surgical device of claim 9,further comprising an articulator configured to allow the first andsecond clamp jaws to articulate with respect to the introducer shaft.12. The surgical device of claim 9, wherein the introducer shaft isremovably coupled to said at least one of the first and second clampjaws.
 13. The surgical device of claim 12, further comprising: a housingcoupled to at least one of the first and second clamp jaws; and whereinthe housing comprises one or more introducer connection points wherebythe introducer shaft is removably coupled to said at least one of thefirst and second clamp jaws by being removably coupled to one of the oneor more introducer connection points.
 14. The surgical device of claim13, wherein at least one of the one or more introducer connection pointsis located in a non-centered position on the housing.
 15. The surgicaldevice of claim 13, further comprising an introducer locking feature.16. The surgical device of claim 13, wherein the introducer lockingfeature comprises: a tie-down suture connection point on the housing; atleast one cleat coupled to the introducer shaft; and a tie-down suturefor coupling to the tie-down suture connection point at a first end ofthe tie-down suture and for removably attaching to the at least onecleat at a second end of the tie-down suture.
 17. The surgical device ofclaim 1, wherein the knotting to hold the first and second clamp jaws ina clamped position comprises at least one mechanical knot.
 18. Thesurgical device of claim 1, further comprising at least one openingconnection point configured to receive an opening suture for opening oneor more of the first and second clamp jaws.
 19. The surgical device ofclaim 1, further comprising at least one closing connection pointconfigured to receive a closing suture for closing one or more of thefirst and second clamp jaws.
 20. The surgical device of claim 19,wherein: at least one of the first and second locking suture guidescomprise the at least one closing connection point; and the at least onelocking suture comprises the closing suture.
 21. A surgical device,comprising: a) first and second clamp jaws, at least one of which ispivotable relative to the other; b) first and second locking sutureguides configured to receive at least one locking suture for knotting tohold the first and second clamp jaws in a clamped position; c) a housingcoupled to at least one of the first and second clamp jaws, wherein thehousing comprises a plurality of introducer connection points; d) anintroducer shaft removably and pivotably coupled to at least one of theintroducer connection points; e) an articulator configured to articulatethe housing with respect to the introducer shaft; and f) an introducerlocking feature comprising: 1) a tie-down suture connection point on thehousing; 2) at least one cleat coupled to the introducer shaft; and 3) atie-down suture for coupling to the tie-down suture connection point ata first end of the tie-down suture and for removably attaching to the atleast one cleat at a second end of the tie-down suture.
 22. The surgicaldevice of claim 21, further comprising: at least one mechanical knot forsaid knotting to hold the first and second clamp jaws in a clampedposition.
 23. A surgical device, comprising: a) a housing comprising afirst pivot point and a second pivot point; b) a first clamp jawcomprising a first clamping surface and a first locking suture guide,wherein the first clamp jaw is pivotable on the first pivot point at alocation between the first clamping surface and the first locking sutureguide; c) a second clamp jaw comprising a second clamping surface and asecond locking suture guide, wherein the second clamp jaw is pivotableon the second pivot point at a location between the second clampingsurface and the second locking suture guide; 1) wherein the first andsecond locking suture guides are configured to receive at least onelocking suture for knotting to hold the first and second clampingsurfaces in a clamped position; and d) at least one suture retainerconfigured to resist separation of the at least one locking suture fromthe first or second clamp jaws.